Nutrition Concerns in Post-Acute Sequelae of COVID-19 Patients

By Malik Tiedt, B.S.P.H. Student in Nutrition

The light at the end of the tunnel is a world without face masks: a previously distant reality where Friday nights are filled with friends, and face-to-face conversations color the definition of normalcy. 

As we approach the post-COVID era with excitement, it is easy to perceive the pandemic as a blip in time that simply becomes part of our shared history. This mindset fails to consider the lasting effects of the coronavirus, particularly regarding growing populations subject to post-acute sequelae of COVID-19 (PASC): a medical condition following COVID-19 infection.

PASC affects multiple organ systems, often manifesting in fatigue, shortness of breath, cognitive impairment (“brain fog”), inflammation, anxiety, depression, and more. Though specialty physicians are making strides in treating various distinct symptoms, recent literature recommends an interdisciplinary approach among providers in post-COVID clinics. This collaborative care must include registered dietitians in the treatment conversation as both COVID-19 and PASC-related symptoms can have severe nutritional implications related to patient recovery.

Nutrition-Related Concerns in PASC Patients

Patients diagnosed with COVID-19 experience symptoms that complicate their ability to meet adequate nutrition requirements. Experiencing persistent symptoms during recovery continues to affect dietary intake and increases the risk of malnutrition, weight loss, and muscle loss. The following list discusses symptoms that raise nutrition-related concerns.

• Respiratory issues, coughing, and shortness of breath complicate the physical processes of chewing and swallowing food. Hospitalized patients may face additional difficulty in consuming food due to periods of mechanical ventilation.
• Loss of taste and smell alter everything from appetite to digestion. For instance, these senses activate the cephalic reflex: a response that prepares the body for nutrient digestion and absorption.
• Increased body temperature (fever) is an inflammatory response that suppresses appetite and contributes to muscle catabolism. During sickness, a larger amount of energy is allocated toward fighting off infection instead of digesting food. 
• Fatigue and weakness can result in a loss of appetite and lack of motivation to cook, prepare, and consume food. Prolonged sedentary behavior can additionally result in muscular atrophy: the weakening of muscle mass needed to help people stand, walk, and maintain a posture conducive to breathing efficiently. 
• Social distancing and isolation. Food sits at the foundation of community, celebration, and tradition. Experiencing persistent COVID-19 symptoms sets patients apart from their friends and families, altering an intrinsic purpose of eating. 

Nutrition Recommendations

Nutrition guidelines endorsed by the Royal College of Nursing, the British Dietetic Association, and British Association of Parenteral and Enteral Nutrition take a personalized approach, stating that nutrient recommendations for PASC patients depend on the diversity of patient body types, the presence of comorbidities (diabetes, cardiovascular issues, asthma, etc.), and the extent of weight loss. Distinctions are also made between patients who have been hospitalized and those who are recovering from COVID-19 symptoms at home. 

Though caloric intake guidelines depend on the amount of weight loss experienced by a particular patient, protein recommendations are generally high. This is meant to help patients recover from muscle loss that contributes to higher rates of infection and poor recovery. When high levels of protein intake are combined with resistance training and light exercise, patients are more likely to experience a quicker return to their pre-illness state of health and functioning. 

Other dietary considerations that have appeared in literature discuss:

• Vitamin D₃ supplementation has been shown to hold antimicrobial and anti-inflammatory properties in vivo. Due to the lack of clinical trials and underpowered studies, routine Vitamin D₃ administration in COVID-19 patients has not been linked to the treatment of moderate to severe symptoms. 
• Oral nutritional supplements (ONS) may be recommended for previously hospitalized patients who experience severe symptoms and malnutrition. These supplements help to increase energy, protein, and micronutrient intake without suppressing a patient’s appetite.
• Hydration is imperative during the COVID recovery period as it supports immune function. Recommendations include consuming fluids that contain calories and electrolytes (e.g. water or sports drinks).

Looking Forward

An interdisciplinary approach for PASC treatment prompts healthcare providers and patients to perceive nutrition in a different light. Whether it be malnutrition screening in recovering hospitalized patients or dietary consultations in populations with less severe symptoms, nutrition will continue to play a vital role in helping our communities heal from a global pandemic. 

The public health crises experienced throughout the past year and a half may begin to subside, but they cannot simply become a part of history. The healthcare system must strive to redefine normalcy in a way that prioritizes nutrition’s ability to maintain wellness and treat disease as part of an interdisciplinary approach. 

Note: This article is intended to foster interest in the nutritional needs and requirements of PASC patient populations. Please see a registered dietitian or primary care provider for nutritional guidance. Click here to find a licensed registered dietitian near you!

Picture credit: Innovative Genomics

Peer-edited by: Gabrielle Dardis, PhD Candidate in Biochemistry and Biophysics